Throughout life, most of us keep an eye on our health and wellbeing. However, there are times when we are more anxious about our health than others. It might be that we need to go back to our GP for a persistent issue, or we need tests or scans to see what is happening.

Now we are in a more extreme situation, with a global pandemic of unprecedented proportions nobody has ever experienced before. The country is in lockdown, and many of us have to shield and isolate for long periods of time in order to keep ourselves safe.

Routine medical procedures and treatments may have been cancelled and some people who are vulnerable might choose not to attend appointments for fear of risking contracting COVID-19. We may know someone who had it, currently has it or perhaps even someone who may have died from it. The news and media are constantly updating us and discussing it.

It seems to be all anybody can talk about.

This can create high levels of anxiety about health and a preoccupation with thinking about the virus and avoiding it at all costs.

Rational Anxiety

It’s important to recognise that anxiety is a perfectly rational response to a crisis situation, particularly if we are in a group who are at risk. It is hardwired into our survival system to want to react and respond when we know there is a threat. Anxiety is an understandable reaction at the moment, and it encourages us to behave in ways that keep us safe in the current circumstances.

For example:

Wanting to isolate or stay at home

Focusing on keeping our environment clean and hygienic

Communicating more with loved ones

Seeking reassurance

Monitoring our sense of wellbeing

Supporting and checking in with vulnerable relatives

Keeping up to date on current advice, guidance and updates from the media

Keeping your distance from others when outside your home

Problematic Anxiety

The difficulty with anxiety is that it can become problematic. Unfortunately the survival system in our bodies is not able to detect between actual danger and a perceived danger. If we get to a stage where our perception of danger is larger than the risk of actual danger, we end up becoming overwhelmed by our anxiety.

This may mean our mental and physical responses become heightened and stay heightened for longer periods of time. When this happens, our anxiety becomes more dominant and in turn we experience an increasing amount of unhelpful behaviours, difficult feelings and physical symptoms.

Signs of problematic anxiety include:

Changes to sleep patterns- you might find it difficult to get to sleep, or wake early in the morning

Mood changes- you may become irritable and bad tempered

Changes to appetite (including nausea, lack of appetite or overeating)

Increased alcohol or smoking

Fatigue

Lack concentration

Body aches and muscle tension

Feeling restless- like you need to constantly keep moving or doing things

Grinding your teeth or experiencing jaw ache and headache

Heart palpitations

Increased rate of breathing

Panic Attacks

Health Anxiety is a specific condition. This is where the above anxiety behaviours can be experienced alongside health-related anxiety behaviours. These tend to centre around fears of being or getting ill that are excessive or create difficulties in everyday life. These behaviours can be obsessive or compulsive, meaning you may feel you have no choice. They can interfere with relationships, work, and other aspects of normal functioning.

Some of these behaviours include:

Refusing to leave the house, even when allowed.

Obsessive checking of media- having the news on all day, constantly checking online, looking up symptoms repeatedly.

Inability to accept reassurance from others, including healthcare professionals

Hypervigilance- closely monitoring those around you for perceived symptoms or signs of illness (coughing is a common one at the moment)

Paranoia- monitoring other people’s behaviour that you believe is a risk to you or others (eg. checking people leaving their house, not observing social distancing or not wearing PPE when in public).

We may briefly experience some of these more problematic aspects of anxiety, particularly health anxiety during the current COVID-19 Pandemic, which is to be expected. These aspects of anxiety will often pass within a few weeks. It is also important to remember that according to WHO: “Illness due to COVID-19 infection is generally mild” and “for most people in most locations the risk of catching COVID-19 is still low” that only 1 in 5 people who do catch it need hospital care.

Anxiety can be managed in the following ways:

Regular sleep pattern

Regular meals

Taking daily exercise, even if it’s a short walk around your garden

Daylight and fresh air- try and keep curtains and a window open

Meditation and mindfulness

Gratitude Journal/ Writing

Yoga and relaxation

Breathing exercises

Regular routine

Talking to others about how you feel

Listening to music

Doing a creative project

Online/Peer support groups

If you are experiencing excessive anxiety that is distressing, lasting longer than a few months or frequent panic attacks, please contact your GP or mental health professional.

When a loved one dies, one of the last things we do for that person is to arrange their funeral. Although this can be upsetting, making these arrangements can play an important role in the grieving process as we try to come to terms with our loss.

As with so many things at the moment, current restrictions mean that the way a funeral is organised has had to change. This is the same whether a person has died due to Covid-19 or any other causes.

When you contact your funeral director to discuss the arrangements, they will be able to tell you about the restrictions that are sadly in place, which can vary between funeral firms and also between crematoria.

Be assured; funeral directors will work hard to accommodate all that you ask for, but they are also required to do all they can to minimise the risk of infection both to the group of mourners and to all those key support workers involved in organising the funeral. Therefore, when you contact them they will be able to advise on such things as:

whether or not it will be possible to visit your loved one in the Chapel of Rest;

whether limousines or transport other than the hearse can be provided;

whether the family are able to act as coffin bearers;

whether the curtains are able to remain open during the service.

In line with Government guidance, funeral services should only be attended by immediate family who are not in a high-risk category, not self-isolating and do not have any symptoms of Covid-19. Advice is to have as small a group as possible to attend the service and many funeral directors are limiting this to ten people or less.

Those who do attend will be asked to follow social distancing guidelines unless they are there with members from their own household. This means staying two metres apart from other people and not being able to embrace or hug them.

Of course these restrictions can be upsetting for the bereaved family and it may feel that the funeral you want for your loved one is not going to be possible.

Do remember that once restrictions have been lifted, it might be possible to hold a memorial service to celebrate the life of the person you have lost and perhaps at that time you can include some of the things you think are missing from the funeral. And of course, you will be able to invite everyone who would like to attend.

For those unable to attend the funeral, there are some things that can be done to make people feel a part of the service:

Discuss with the funeral director if they can live stream the service;

Have someone film it or take photos to share afterwards;

Give everyone you would normally contact, the date and time of the funeral so that people are able to mark the occasion in their own homes should they wish to do so. This could be by lighting a candle, reading a prayer or playing a significant piece of music.

People can be asked to share a memory about the deceased which can be collated and shared at some future point, perhaps at a memorial service.

Also, for those who have been cared for by Oakhaven, the Oakhaven Chaplaincy team is able to assist with funeral planning and leading of services. For more information ask for a Help Planning a Funeral booklet and/or email FAS@oakhavenhospice.co.uk or contact the Oakhaven Chaplain on 01590 670346 or paul.hatchard@oakhavenhospice.co.uk

It’s the conversation no one wants to have isn’t it? In fact, in a survey conducted by the charity Dying Matters they found that 72% of the British public are uncomfortable discussing dying, death and bereavement. It’s true that it’s an uncomfortable subject – we’d rather not think about it. Yet if the subject is bravely broached; it can make all the difference for everyone involved.

The time after someone close to us dies can be a very busy period. Several tasks need to be done. A medical certificate from the GP needs to be sought so we can register the death. Much of our time might be spent letting others know that our loved one has died. Authorities such as insurance companies and the DVLA need to be informed. On top of that there’s the funeral to arrange and we do all this while trying to live with our grief and coming to terms with what has happened. This time can be even harder to bear if there’s been no prior thought or planning for when the time does come.

We don’t have to be ill or dying to begin these conversations and to put plans in place. Perhaps we fear that by talking about death it will somehow bring it closer. It won’t. When we have these conversations and begin making plans we find we are planning for life – because it allows us to make the most of the time that we have.

The kind of conversations we may want to have could include discussions around:

Where we might like to die (e.g. at home or in a hospice)

Writing a will

Making financial plans so that the people we care about are protected

Registering for organ donation

Setting up a Lasting Power of Attorney – writing an advance care plan and discussing wishes with our GP

Our funeral wishes

Whether we have any particular worries we’d like to discuss about being ill and dying.

These are just a sample of the concerns we may have. Sometimes the conversations themselves can feel like the biggest hurdle. How do we courageously begin to have these discussions?

Begin to look for little invitations to talk i.e. if you’re talking about future holiday plans and they say “who knows where I’ll be then”- it may indicate that they’re ready to talk

Choose the right place and the right time. No one finds it easy when they’re rushed or in a stressful situation

Plan what it is you might want to ask or discuss in advance, but if the other person begins to feel uncomfortable – don’t pursue it. They may decide they want to talk at a later date

Listen to what the other is saying, rather than always steering the conversation

Give space for strong feelings. It’s ok to feel lots of different emotions during and after these conversations

Knowing loved ones wishes can bring peace of mind to the person who is dying and to those left behind as it provides space to grieve without worrying what their loved one wanted. One lady whose daughter bravely started a conversation with her said afterwards how relieved she felt as she had wanted to raise the subject herself for a long time.

Having the conversation can make all the difference. The charity Dying Matters provides all kinds of helpful information including further advice on how you can begin talking about these things: https://www.dyingmatters.org.uk

The Oakhaven Chaplaincy team is able to assist with funeral planning and leading of services for patients being cared for by Oakhaven. For more information ask for a Help Planning a Funeral booklet and/or email FAS@oakhavenhospice.co.uk or contact the Oakhaven Chaplain paul.hatchard@oakhavenhospice.co.uk

Life has suddenly been turned up-side down for all of us and not least our children and young people because of the outbreak of Covid-19. Schools, colleges and universities have closed early. There may not be any transition preparations for going to the next stage for primary school children nor proms which are the traditional way of ending secondary school. There will be no exams which many have been working towards. Children and young people may have to find other ways to say their goodbyes to friends and teachers.

You may also be having to home-school your children which can also bring new challenges to life at home.

This can leave many with a sense of loss and anxiety as nobody knows what comes next!

Anxiety may appear in different ways.

Emotionally, children and young people may appear upset, distressed, anxious, angry, and agitated or fearful. Behaviourally they may be clingy, withdrawn, they wet the bed or have problems sleeping. Physically they could be experiencing stomach ache or headache.

It is particularly important to let children and young people know what is going on as they are more aware than we may think.

You may want to consider certain points which will benefit both yourself and the children before talking:

Choose a calm moment to talk

Don’t be afraid to talk about Covid-19

Make sure you know what you are talking about, find the facts

Let them know that they can come to you when they need to talk

Don’t dismiss anything they might bring up

Try not to avoid difficult questions. You can suggest that you look it up or you can say you don’t know

Think about and decide how much they need to know

Talk about good news too!

Limit exposure to news on TV and social media.

You can talk to children about the importance of staying at home. Stay up-to-date with the latest guidelines via the NHS and GOV.UK websites.

Children like to help and to get them involved you can explain the importance of washing hands with soap and water which helps to fight the virus: Wash hands for 20 seconds – the time it takes to sing “Happy Birthday” twice.

If they have a cold tell them to use a tissue and follow the guidelines: Catch it, Bin it, Kill it!

We all function much better when we have a purpose in our day and therefore it is helpful to continue with a routine. You can make a plan or timetable together. Let the children help to decide what to put on it and what it should look like. Keep it where it is visible, for example on the fridge.

Activities include:

Encourage them to play outside

Free time- allow them to select things to do for themselves

Talking with friends or family using things like video calls

Try and keep bedtime routines in place, and limit screen time an hour before going to bed

Try and spend time together doing something they enjoy such as baking or drawing or reading a story

The BBC and the NHS have ideas and advice for activities while staying home during the coronavirus outbreak.

The advice for older children and teenagers is very similar.

Working with them, try and negotiate a rough routine that works. It may need changing as lockdown continues.

Try and keep regular bedtimes, and avoid using devices in bed.

Try to learn something new like gardening, cooking, learning to play an instrument or a new language.

Homework- older children will have online platforms organised by schools for them to complete work and interact with their class and teacher.

Make use of the daily allowed walk, run or cycle ride.

Don’t forget to look after your mental health. Consider using mindfulness apps such as Headspace.

When we have a loved one who is being cared for at the end of life, the choices and decisions we make matter. A key part of palliative care is about helping people make informed decisions in advance if they can; for example about where they want to die and how much medical intervention they might want when they become more unwell. This all forms the picture of what is known as a ‘good death’.

Where possible palliative care teams like to involve and support family members and other people close to the patient when making these decisions. Unfortunately however due to COVID-19, situations are arising where family are self-isolating and not able to be with their loved one at critical times including sadly when they are dying. Services are restricting visitors and others may stop visiting altogether.

This can be distressing for people for many reasons:

They may be used to seeing their loved one daily, particularly if they are a spouse, partner or someone they have been caring for at home.

They may have to stay away from their loved one for longer periods of time. Self-isolation is often at least 7 days, or 14 if you live with others. This can feel like a long time for someone if they know their loved one maybe in the last few weeks of life.

Choosing to be there and saying ‘goodbye’ towards the end and at the moment of death is an important part of the grieving process. Physical connection can be as important in death as it is in life, and people may wish they could hold their hand or offer comfort.

People may no longer have access to their usual ways of coping. Whether this is attending church, going to the gym, seeing a friend for coffee or going to see family, these things are no longer accessible.

When you are in self-isolation, these choices are taken away from you and can leave you feeling a whole host of feelings, from helplessness and frustration to numbness and distress.

Here are some suggestions to help you and your family cope with this:

Try and think about this situation ahead of time, and plan to put things in place to support you, your family and your loved one. Don’t be afraid to have difficult conversations a bit earlier than you’d thought.

Talk about what you can do for one another- if someone is able to visit, can they take gifts or help facilitate phone calls while they are there?

Use digital communication where you can. Video calls can be valuable.

Work with healthcare staff. This is an ongoing situation and will change. Nominate one member of the family to contact the unit regularly to get updates and then share with the rest of the family.

When speaking to healthcare staff, think about questions you have ahead of time and what you want to know.

Write letters, ask children to draw pictures, print photos and send them to your loved one for them to look at and read.

Record audio or video messages from family via a messaging app. These can be replayed and kept if needed.

Try and keep a rough routine for when you are self-isolating in order to maintain some normality within life at home.

Allow yourself some time to sit with your feelings. Don’t be afraid to cry, this is an understandable reaction to a difficult situation.

Choose an item of your loved one’s clothing, a cushion or something meaningful, and hold it close to you. This will offer some physical comfort.

Focus on looking after yourself. It may be the last thing on your mind, but spending some time focussing on your own wellbeing is important.

Think about self-care that you can do. Can you alter your usual coping methods? For example, rather than meeting a friend for coffee, arrange a phone call with a friend at 11am and have a chat while you have your coffee at home.

Get outside. Try and get some time outside in the fresh air if you can. This can help clear your mind and calm you down.

Reach out to others in your family. Many will be at home and most likely able to take a phone call.

Ask for help if you are becoming very distressed. Phoning a support line can help.

Please don’t stop reading already, I am not going to be suggesting we ‘om’ ourselves through the next four months,,,,

We are, indeed, living in a time of crisis unprecedented in our lifetimes and it is an extremely uncomfortable experience, whether we are frontline professionals or witnesses to the experiences of others.

Mindfulness shows us that experience is sensed first (sight sound smell touch taste) and then interpreted by the mind, albeit so fast we don’t realise it. How we feel emotionally becomes how we feel physically.

When this is the total of how we experience our life, we can become tired and drained.

I found a great Rumi quote: ‘Don’t be the rider who gallops all night and never sees the horse that is beneath him’.

If you wish to, try this noticing exercise: If you can, have a small drink with you and take a couple of really small sips before you begin, barely enough to wet your lips.

Then, see if you can gently begin to take your attention along the highlighted words below. Just notice your responses, this is not a test.

How are you feeling now? Perhaps you got two words along and didn’t want to continue. That’s ok, it’s not a test. Notice whether you are judging any of your responses and then simply take a sip of your drink. Try to stay aware of swallowing it. Then, if you wish to, continue the exercise

Direction Unknown Pause Unbalanced Relief Exhausted Resolve Isolated

Allow Discomfort Brave Uneasy Heightened Spacious Stressed Rested

Revived Relaxed Centered Known Dread Grounded Yield

Perhaps you chose to stop next to a particular word. Notice how you feel now. If you wish to reflect on the experience, see if you can do that from a sense of curiosity. There is no right or wrong, simply your awareness of your experience.

Mindfulness can’t cure the Coronavirus or change what is happening, but it can change the way we experience ourselves in it. By developing a non-judgmental self-awareness we give ourselves the chance to choose a gentler perspective with some moments of mindfulness.

In troubled times it can be difficult to trust that the simplicity of a moment of mindfulness will make any difference at all. If a mindful moment is simply ‘stopping to notice the shape and rhythm of your breathing and see if it could soften and deepen back into a regulated pattern without judging any of the process’ (mindful.org), it might feel too simple to help us work through such difficult moments, as the effort of galloping through the night on our horse as Rumi suggests. But it doesn’t mean we won’t try and help, rather support ourselves while we are trying.

If the idea of mindfulness is too much like navel-gazing for you, try thinking of it as being a great tactician.

Whatever the words are that will invoke in you an awakening to the fact that a mind that needs to achieve needs a body that can carry it, please don’t stop here…..

Journeys bring power and love

back into you.

If you can’t go somewhere,

move in the passageways of the self.

They are like shafts of light,

always changing, and you change

when you explore them.

Jalaluddin Rumi

13th Century Sufi Poet

If you would like to know more about mindfulness and how it can help, here are some links and suggestions:

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